title: Does a bed rail system of alcohol-based handrub antiseptic improve compliance of health care workers with hand hygiene? Results from a pilot study.
abstract: BACKGROUND
  Hand hygiene is the cornerstone of prevention of nosocomial infections and a challenge for infection-control teams.
  
  
  METHODS
  Bed-rail dispensers of alcohol-based hand rub antiseptic (AHRA) were first initiated only in department A (period I), followed by department B (period II). Opportunities for hand hygiene (OHH) were recorded during periods I, II, and III (post-trial follow-up). Only application of AHRA before and after contacting each patient was considered as appropriate. Comparative evaluation between periods I and II, as well as II and III, was performed. Predictors of AHRA compliance were also assessed by regression analysis.
  
  
  RESULTS
  HCWs' compliance was improved after the initiation of the bed-rail approach in department B (51.5%, vs 36.4% P = .005). In department A, where this system already existed, no changes were observed. The bed-rail AHRA system (P = .007 [OR 1.8(1.2-3.0)]) and nurses (P < .0001[OR 5.6 (3.1-9.9)]) were predictors of hand hygiene in department B. HCWs' compliance declined in department B (26.5% vs 51.5%, P < .0001) and department A (27.5% vs 35.9%, P = .1) during period III.
  
  
  CONCLUSIONS
  The bed-rail approach initially improved HCWs' compliance with AHRA but did not radically influence behavior in internal medicine settings. Multidisciplinary strategies are required to establish hand hygiene recommendations.
authors.affiliation: Fourth Department of Internal Medicine, Athens Medical School, ATTIKON University General Hospital, Athens, Greece. gianiemi@hotmail.com
authors.forename: Efthymia
authors.initials: E
authors.lastname: Giannitsioti
authors.forename: Sophia
authors.initials: S
authors.lastname: Athanasia
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antoniadou
authors.forename: Helen
authors.initials: H
authors.lastname: Fytrou
authors.forename: Kalomoira
authors.initials: K
authors.lastname: Athanassiou
authors.forename: Paschalia
authors.initials: P
authors.lastname: Bourvani
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kanellakopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kouvelas
authors.forename: Antonios
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Diamantis
authors.initials: D
authors.lastname: Plachouras
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods*; D006282:Health Personnel; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects